gms | German Medical Science

Background: Crohn’s disease (CD) and ulcerative colitis (UC) are the major types of inflammatory bowel disease (IBD). Beside intestinal symptomes such as abdominal pain, diarrhea, bleeding and malabsorption, arthritis is the most common extraintestinal manifestation but its exact prevalence is unknown. The GEPARD (German Psoriatic Arthritis Diagnostic) questionnaire was developed to filter out patients with probable Psoriatic Arthritis among patients with psoriasis. In lack of a better method we used GEPARD to identify possible patients with enteropathy associated arthritis [EAA].

Objectives: To figure out the prevalence of IBD patients of South Württemberg having an EAA.

Methods: 9 private practices (in South Württemberg, Germany) and one university Hospital (Tuebingen) participated. During the evaluation period (09/2014 - 10/2016) 422 patients with IBD filled out the GEPARD questionnaire. Patients ticking more than 4 questions with “yes” were invited and examined by the author [N: 111]. All patients underwent further imaging examination if symptomatic. Blood samples were taken.

Results: 422 patients filled out the questionnaires, 22 dropouts were counted. We detected 80 patients (20%) having an EEA (25% UC vs. 75% CD). 49 of them obtained the diagnosis from the results of our investigations, further 31 patients from earlier investigations. 32,7% of the above had an axial manifestation, 32,7% a peripheral one, the rest (34,7%) both. X-ray detected only once an arthritis vs. 10 cases of sacroilitis. Ultrasound (US) was performed in 81,1% of all patients detecting an arthritis in 33. MRI of the spine was done in 33 patients, detecting 19 cases with any kind of axial manifestation. MRI of the sacroiliacal joint was performed in 39 patients showing a sacroiliitis in 11. An MRI of the joints (usually radiocarpal joint) was performed in 40 patients detecting an arthritis in 20. Only 8 (7,2%) of all examined patients were HLA B27 positive, with 6 fullfilling the criteria of an EEA (5 cases with sacroiliitis or spondyloarthritis and 1 isolated arthritis of the hip). Rheumatoid factor (RF) was positive in 2 patients, ACPA in none. 16 patients showed elevated ANA without further differentiation. There was no significant difference in the ESR (10 vs. 11,5 mm/h) und CRP (0,32 vs. 0,31 mg/dl) levels between IBD patients with or without EAA.

Conclusion: 20,0% of all IBD patients living in South Wuerttemberg seem to have an EAA. 61,3% of them [N: 49] received the diagnosis after a complete rheumatological examination in our clinic. About 1/3 of them have simultaneously an arthritis and a spondylitis, 1/3 only arthritis and 1/3 only spondylitis. X-ray should perhaps performed only to detect a radiological sacroiliitis. US and MRI seem to be more useful detecting a peripheral arthritis. Patients with spinal pain should obtain an MRI. A positive HLA-B27 status seems to be less common than expected (about 10%, mostly with an axial manifestation). RF and ACPA measurements do not predict the presence of EAA but may be useful for differential diagnosis. Measuring ESR and CRP we could not find any significant difference. There is no questionnaire specifically dedicated to identifying IBD patients with EAA. The GEPARD questionnaire may be adequate for prescreening of patients with IBD.